Abstract

Objectives

In recent years, the European euthanasia debate has become more intense, and the practice was legalized in the Netherlands, Belgium, and Luxembourg. We aimed to determine the current degree of public acceptance of euthanasia across Europe and investigate what factors explain differences.

Methods

Data were derived from the 2008 wave of the European Values Survey (EVS), conducted in 47 European countries (N = 67,786, response rate = 69 %). Acceptance of euthanasia was rated on a 1–10 scale.

Results

Relatively high acceptance was found in a small cluster of Western European countries, including the three countries that have legalized euthanasia and Denmark, France, Sweden and Spain. In a large part of Europe public acceptance was relatively low to moderate. Comparison with the results of the previous EVS wave (1999) suggests a tendency towards a polarization in Europe, with most of Western Europe becoming more permissive and most of Eastern Europe becoming less permissive.

Conclusions

There is roughly a West-East division in euthanasia acceptance among the European public, making a pan-European policy approach to the issue difficult.

Notes

Acknowledgments

Joachim Cohen is a postdoctoral Fellow of the Research Foundation - Flanders (FWO). This study used data of the European Values Study 2008, 4th wave, Integrated Dataset. GESIS Data Archive, Cologne, Germany, ZA4800 Dataset Version 2.0.0 (2010-11-30), doi:10.4232/1.10188. The analyses and writing activities were funded by a grant from the Research Council of the Vrije Universiteit Brussel (HOA27). We would like to thank Jane Ruthven for proofreading and copy editing the manuscript.

Which of these statement comes closest to your beliefs (one of four statements ranging from ‘there is a personal God’ to ‘I don’t really think there is any sort of spirit, God or life force’)

0.744

How important is God in your life

0.871

Do you get comfort and strength from religion?

0.831

Do you take moments of prayer/meditation?

0.728

How often do you pray to God outside religious services?

0.838

Tolerance towards freedom of personal choicesb

Please tell me whether you think … can always be justified, never be justified, or something in between:

Divorce

0.783

Abortion

0.779

Having casual sex

0.689

Prostitution

0.686

Suicide

0.642

Invitro fertilization

0.604

Homosexuality

0.759

Anti-democratic attitudesc

Agreement to statement: Democracies aren’t good at maintaining order

0.783

Agreement to statement: In democracy, the economic system runs badly

0.763

Agreement to statement: Democracies are indecisive and have too much squabbling

0.715

Agreement to statement: Democracy may have problems but it’s better than any other form of government

−0.581

Having a democratic system is a very good, fairly good, fairly bad or very bad way of governing this country

−0.597

avariance explained: 61.83 %; Cronbach’s alpha: 0.84

bvariance explained: 50.25 %; Cronbach’s alpha: 0.84

cvariance explained: 48.0 %; Cronbach’s alpha: 0.73

Tables 3

Results of the ANCOVA analysis

Source

Type III Sum of Squares

Df

Mean square

F

Sig.

Partial η2

Tests of between-subjects effects

Intercept

393585.3

1

393585.3

51424.7

<0.001

0.502

Country

34868.2

45

774.8

101.2

<0.001

0.082

Age (6 groups)

1694.7

5

338.9

44.3

<0.001

0.004

Educational

991.1

2

495.6

64.8

<0.001

0.003

Sex

66.9

1

66.9

8.7

0.003

0.000

Municipality size

882.4

1

882.4

115.3

<0.001

0.002

Income Level

441.7

2

220.9

28.9

<0.001

0.001

Religiosity

17057.8

1

17057.8

2228.7

<0.001

0.042

B

95 % confidence interval

Sig.

Partial η2

Parameter estimates

Intercept

2.45

2.24–2.66

<0.001

0.010

Country

Albania

0.61

0.39–0.84

<0.001

0.001

Azerbaijan

1.14

0.94–1.34

<0.001

0.002

Austria

2.20

1.98–2.43

<0.001

0.007

Armenia

0.75

0.53–0.96

<0.001

0.001

Belgium

4.15

3.92–4.37

<0.001

0.026

Bosnia Herzegovina

1.18

0.96–1.40

<0.001

0.002

Bulgaria

2.01

1.79–2.22

<0.001

0.006

Belarus

2.53

2.32–2.75

<0.001

0.010

Croatia

2.04

1.83–2.26

<0.001

0.007

Cyprus

0.28

0.03–0.53

0.03

0.000

Northern Cyprus

1.73

1.43–2.03

<0.001

0.003

Czech Republic

2.41

2.18–2.63

<0.001

0.009

Denmark

4.10

3.86–4.35

<0.001

0.021

Estonia

1.96

1.74–2.18

<0.001

0.006

Finland

3.27

3.03–3.51

<0.001

0.013

France

3.91

3.69–4.13

<0.001

0.023

Georgia

0.72

0.50–0.93

<0.001

0.001

Germany

1.95

1.74–2.16

<0.001

0.006

Greece

1.62

1.40–1.85

<0.001

0.004

Hungary

2.02

1.80–2.24

<0.001

0.006

Ireland

1.74

1.42–2.06

<0.001

0.002

Italy

2.68

2.43–2.92

<0.001

0.009

Latvia

2.43

2.21–2.65

<0.001

0.009

Lithuania

2.76

2.54–2.98

<0.001

0.011

Luxembourg

3.56

3.33–3.80

<0.001

0.016

Malta

1.14

0.85–1.44

<0.001

0.001

Moldova

0.79

0.57–1.00

<0.001

0.001

Montenegro

0.97

0.75–1.18

<0.001

0.001

Netherlands

4.05

3.83–4.28

<0.001

0.024

Norway

2.90

2.67–3.14

<0.001

0.011

Poland

1.55

1.33–1.77

<0.001

0.004

Portugal

2.85

2.59–3.12

<0.001

0.009

Romania

1.55

1.34–1.77

<0.001

0.004

Russian Federation

2.07

1.85–2.29

<0.001

0.007

Serbia

1.76

1.54–1.98

<0.001

0.005

Slovak Republic

2.32

2.10–2.54

<0.001

0.008

Slovenia

3.20

2.95–3.45

<0.001

0.012

Spain

3.59

3.35–3.83

<0.001

0.016

Sweden

3.52

3.28–3.76

<0.001

0.016

Switzerland

2.70

2.46–2.95

<0.001

0.009

Turkey

0.96

0.75–1.17

<0.001

0.002

Ukraine

1.77

1.55–1.99

<0.001

0.005

Macedonia

1.24

1.03–1.45

<0.001

0.003

Great Britain

3.17

2.90–3.43

<0.001

0.01

Northern Ireland

2.52

2.12–2.91

<0.001

0.003

Kosovo

Ref cat

.

.

Age (years)

18–29

0.58

0.49–0.68

<0.001

0.003

30–39

0.62

0.52–0.71

<0.001

0.003

40–49

0.57

0.48–0.66

<0.001

0.003

50–59

0.43

0.34–0.53

<0.001

0.002

60–69

0.27

0.17–0.36

<0.001

0.001

70 and older

Ref cat

.

.

Educational attainment

Low (primary or lower)

−0.54

−0.64 to 0.45

<0.001

0.002

Mid (secondary)

−0.24

−0.29 to 0.18

<0.001

0.001

High (post secondary)

Ref cat

.

Sex (male vs. female)

−0.07

−0.12 to 0.03

0.003

0

Municipality size (<100,000 vs. >100,000 inhabitants

−0.31

−0.37 to 0.26

<0.001

0.002

Income

Low (<500 euro)

−0.41

−0.52 to 0.30

<0.001

0.001

Mid (500–2,500 euro)

−0.22

−0.31 to 0.14

<0.001

0.001

High (2,500 euro and higher)

Ref cat

.

.

Religiosity (factor score)

−0.70

−0.73 to 0.67

<0.001

0.042

R² of the model = 0.257

Ref cat reference category

Tables 4

Results of linear mixed-effects model analysis

Parameter

Estimate

Std. error

df

t

Sig.

95 % confidence interval

Parameter estimates of fixed effects

Intercept

2.54

0.18

1170.4

14.19

<0.001

2.19–2.89

Country

Albania

0.43

0.18

1288.6

2.34

0.02

0.07–0.79

Azerbaijan

0.97

0.18

1135.5

5.31

<0.001

0.61–1.33

Austria

2.07

0.18

1295.5

11.30

<0.001

1.71–2.44

Armenia

0.39

0.19

1261.6

2.02

0.04

0.01–0.77

Belgium

3.99

0.19

1327.0

21.55

<0.001

3.63–4.36

Bosnia Herzegovina

0.98

0.19

1274.8

5.24

<0.001

0.62–1.35

Bulgaria

1.95

0.18

1261.9

10.67

<0.001

1.59–2.31

Belarus

2.45

0.18

1212.8

13.55

<0.001

2.10–2.81

Croatia

2.01

0.18

1225.7

11.03

<0.001

1.65–2.37

Cyprus

0.14

0.22

1262.1

0.63

0.53

−0.29 to 0.57

Northern Cyprus

1.54

0.24

1040.9

6.43

<0.001

1.07–2.01

Czech Republic

2.35

0.19

1512.7

12.11

<0.001

1.97–2.73

Denmark

3.96

0.20

1597.5

20.11

<0.001

3.58–4.35

Estonia

2.19

0.19

1372.8

11.62

<0.001

1.82–2.55

Finland

3.09

0.19

1510.7

16.12

<0.001

2.72–3.47

France

3.88

0.19

1452.7

20.31

<0.001

3.50–4.25

Georgia

0.36

0.21

1115.1

1.69

0.09

−0.06 to 0.77

Germany

2.03

0.18

1295.7

11.01

<0.001

1.67–2.39

Greece

1.70

0.19

1364.3

8.81

<0.001

1.32–2.07

Hungary

1.91

0.18

1272.5

10.44

<0.001

1.55–2.27

Ireland

1.78

0.22

2247.1

7.91

<0.001

1.34–2.22

Italy

2.87

0.19

1507.2

14.87

<0.001

2.49–3.25

Latvia

2.32

0.18

1262.1

12.67

<0.001

1.96–2.67

Lithuania

2.65

0.18

1277.1

14.43

<0.001

2.29–3.01

Luxembourg

3.30

0.19

1463.0

17.37

<0.001

2.93–3.67

Malta

1.29

0.25

964.0

5.10

<0.001

0.79–1.79

Moldova

0.72

0.20

1215.5

3.62

<0.001

0.33–1.11

Montenegro

0.84

0.18

1223.5

4.62

<0.001

0.48–1.20

Netherlands

3.75

0.18

1312.9

20.31

<0.001

3.38–4.11

Norway

2.67

0.19

1528.2

13.79

<0.001

2.29–3.04

Poland

1.50

0.19

1358.5

7.75

<0.001

1.12–1.89

Portugal

2.73

0.20

1696.6

13.84

<0.001

2.34–3.12

Romania

1.25

0.21

1194.5

6.02

<0.001

0.84–1.66

Russian Federation

2.04

0.18

1243.4

11.17

<0.001

1.68–2.39

Serbia

1.63

0.18

1247.0

8.93

<0.001

1.27–1.99

Slovak Republic

2.18

0.18

1236.4

12.02

<0.001

1.83–2.54

Slovenia

2.98

0.20

1608.3

15.27

<0.001

2.60–3.36

Spain

3.30

0.19

1502.3

17.23

<0.001

2.92–3.67

Sweden

3.21

0.20

1686.3

15.95

<0.001

2.82–3.61

Switzerland

2.62

0.19

1523.8

13.64

<0.001

2.24–2.99

Turkey

1.01

0.24

800.3

4.19

<0.001

0.54–1.49

Ukraine

1.58

0.18

1276.6

8.57

<0.001

1.22–1.94

Macedonia

1.14

0.18

1187.9

6.28

<0.001

0.78–1.50

Great Britain

2.99

0.20

1843.8

14.64

<0.001

2.59–3.40

Northern Ireland

2.41

0.25

3639.2

9.60

<0.001

1.92–2.91

Kosovo

Ref cat

.

.

.

.

Age (years)

18–29

0.56

0.05

51015.1

11.66

<0.001

0.46–0.65

30–39

0.59

0.05

51020.5

12.17

<0.001

0.50–0.69

40–49

0.54

0.05

51021.0

11.38

<0.001

0.45–0.64

50–59

0.41

0.05

51014.0

8.60

<0.001

0.32–0.51

60–69

0.26

0.05

50999.8

5.26

<0.001

0.16–0.35

70 and older

Ref cat

.

Educational attainment

Low (primary or lower)

−0.51

0.05

50973.2

−10.12

<0.001

−0.61 to 0.41

Mid (secondary)

−0.24

0.03

51010.5

−8.17

<0.001

−0.30 to 0.18

High (post secondary)

Ref cat

.

.

.

Sex (male vs. female)

−0.07

0.03

51019.9

−2.62

0.01

−0.12 to 0.02

Municipality size (<100,000 vs. >100,000 inhabitants

−0.30

0.03

51019.1

−10.20

<0.001

−0.35 to 0.24

Income

Low (<500 euro)

−0.40

0.05

51002.3

−7.32

<0.001

−0.50 to 0.29

Mid (500–2,500 euro)

−0.19

0.04

51014.9

−4.40

<0.001

−0.27 to 0.10

High (2,500 euro and higher)

Ref cat

Religiosity (factor score)

−0.70

0.05

45.9

−13.36

<0.001

−0.81 to 0.60

Estimates of covariance parameters

Parameter

Estimate

Std. error

Wald Z

Sig.

95 % confidence interval

Residual

7.57

0.05

159.7

<0.001

7.48–7.67

Religiosity (subject = country)

0.11

0.03

4.3

<0.001

0.07–0.18

Explanatory note: the model adjusted for the variation of the religiosity effect owing to country variation. The parameter estimates of fixed effects present the effects of the different variables on euthanasia acceptance and are similar to those in the ANCOVA model. The estimates of covariance parameters indicate that there is a significant variation of the religiosity effect due to country variation

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